PRESENT/PAST PERFORMANCE QUESTIONNAIRE – RFP SPE4A615R0340

PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT YOURSELF:

Name/Signature and Role Relative to Contract (e.g. Buyer, Program Manager):_____________________________________________________________________________________________

  _____________________________________________________________________________________________________

Agency or Business:  ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Address:  ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Telephone No.  _______________________________                           FAX No.  ____________________________________ 

Return your completed questionnaire either electronically, or by mail*.*

NOTICE:  WHEN COMPLETED, THIS QUESTIONNAIRE WILL BE CONSIDERED SENSITIVE AND SHALL NOT BE RELEASED TO THE OFFEROR.

PART I. SPECIFIC PROGRAM INFORMATION.

Contractor/Business: _____________________________________________		                    CAGE Code: __________

Program Title and Brief Description: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Role in the Program/Work Performed As:	_____Prime	_____Subcontractor	_____Vendor/Supplier

Contract Number: ________________________________             Number of Years?:     Basic:________   Option: _________

Contract Type(s): List all applicable contract types, i.e. Firm-Fixed-Price, Time & Materials, Cost, etc._________________________________________________________________________________________________________

PART II. GENERAL PROGRAM INFORMATION.

Period of Performance:	

1.  Original Schedule (assuming all options exercised): Beginning Date _________ through ____________

2.  Current Schedule (assuming all options exercised): Beginning Date _________ through ____________

3.  Reason for difference (if applicable) ___________________________________________________________________________

Contract Dollar Value:  

1. Original MAX Contract $ Value (assuming all options are exercised:  _________________________________________

	2.  Current MAX $ Value (assuming all options exercised):    ____________________________________________________

	3.  Primary Causes of Changes:  ___________________________________________________________________________

NOTE:  In Part III, should your response be other than “satisfactory,” please provide supporting documentation in “Additional Remarks” on page 3.

PART III.PERFORMANCE ASSESSMENTS*.*

Please check the appropriate rating for each of the following questions (see definitions on page 4):  

U= Unknown Confidence        NC= No Confidence      LC=Limited Confidence      SC= Satisfactory Confidence   SU C= Substantial Confidence

13.  Has action been initiated to cancel or terminate the contract for default? If yes, explain. ________________________________________________________________________________________________________________________________________________________________________________________________________________________

14.  Have there been any disputes/claims relative to the contract? If yes, explain.

_______________________________________________________________________________________________________________________________________________________________________________________________________________________

15.  Describe the contractor’s or company’s strong and/or weak points identified as a result of technical performance and any technical performance risk identified during the life of the contract. 

_______________________________________________________________________________________________________________________________________________________________________________________________________________________

16.  If given a choice, would you award to this contractor again?  If not, please explain. _______________________________________________________________________________________________________________________________________________________________________________________________________________________

17.  Do you feel you “got what you paid for” ?   Please explain.  ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

18.  Additional Remarks.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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ASSESSMENT RATING SYSTEM

NOTICE TO QUESTIONNAIRE RESPONDENTS:  Please do not include this page when returning the completed questionnaire. 

SOURCE SELECTION INFORMATION

SEE FAR 2.101 AND 3.104 FOR OFFICIAL USE ONLY	Page 1